Explain how changing demographics are impacting patients and providers in the delivery of health care in the U.S. Describe the impact of increased diversity in and around the health care industry.
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Assignment Reading Brake Down:
The health care industry provided approximately 14.6 million jobs in 2004 alone, making it one of largest employers in the United States. Registered nurses, the largest employed group in health care, estimated 2.9 million jobs and physician numbers reached about 885,000, with a majority working in metropolitan areas.
Physician assistants and nurse practitioners are steadily climbing the employment ladder within the industry as well. And though there are a number of other specialized professionals and nonprofessionals employed in the industry, there are also more jobs that do not require a four-year college degree.
For our discussion on credentialing and licensure this week, we will focus on those professionals that diagnose and treat patients.
Barton, P.L. (2010). Understanding the U.S. health services system (4th ed.). Chicago, IL: Health Administration Press.
Licensure, Certification, and Credentialing
After academic and clinical training is completed, clinical professionals are required by law to attain their licensure and/or certification to practice. Most physicians are eligible to obtain a license to practice medicine after one year of post-graduate training. Licensure is granted by the state. It is required for physicians, nurses, and others to practice, and demonstrate competency to perform a scope of practice. State Boards of Physician Quality Assurance (BPQA) establish requirements for medical licenses. In the field of nursing, the National Council Licensure Examination must be passed by nursing students to obtain their licenses. In some states a criminal background check is also required for both RN and MD licensure. This information is available to those who screen, hire, and/or evaluate personnel through the National Practitioner Data Bank. Not only does this data bank provide the list of practitioners, it provides the scope of practice for the specific license. This is an important tool for leaders and human resources managers to avoid any major lawsuits.
Now that we have looked at the licensure, let’s move on the certification requirements.
The level of certification in health services depend on the practitioner being examined. A physician, who has submitted the documentation of education, training, and practice to the American Board of Medical Specialties (ABMS) for review, does so voluntarily. Upon approval of the medical specialty board and successful completion of examinations, the physician is designated as board certified in that specialty. Certificates are time-limited. Physicians must demonstrate continued competency and retake the exam every six to ten years, depending on the specialty. Board certification is a form of credentialing a physician’s competency in a specific area.
For staff privileges and hiring purposes, most hospitals, health maintenance organizations (HMOs), and other health care organizations require a physician to be board certified or board eligible, i.e., preparing to sit for the exams. Board certification is used as proxy for determining the quality of a health professional’s services. Assumption of quality is based on research that more education and training leads to a higher quality of service.
Physician credentialing is the process of verifying information that a physician supplies on an application for staff privileges at a hospital, HMO, or other health care organization. Physician credentialing is a time-consuming, labor-intensive, costly process that must be repeated every two years. When physicians apply for privileges at a hospital, they must specify what they want, not only by specialty, but in the surgical specialties, by procedure. The hospital must conduct diligent research on that surgeon before granting privileges, or it can be held liable in a court of law for allowing an incompetent physician on its staff. It is preferable to obtain primary verification and documentation, i.e., to contact each place individually by phone and obtain original documents, such as transcripts with raised seals.
As a health care manager, you may find yourself working in the physician relations and credentialing department and you may be responsible for determining whether the credentials offered by a physician are legitimate. Physician credentialing requires excellent interpersonal skills, organizational skills, persistence, an eye for details, and the ability to identify inconsistencies in data. Another major role of management is to keep the health care team focused on the same goals. The resistance of employees, both clinical and nonclinical, can lead to interpersonal conflict, potentially poor patient outcomes, and tense organizational climate. Therefore, management must forge an organizational climate that promotes strong team relations, job satisfaction, and high retention.
Diversity in Health Care
Let’s discuss understanding and managing your employees based on the various differences among them. Cultural competency and diversity in health care management are more important today than in any time of the industry’s history.
Historically, diversity is defined by categorical markers such as age, sexual orientation, religion, and ethnicity. Not only must one consider the prolific numbers of ethnic groups in the United States, but also consider factors relevant to their minority status, such as groups that are migrants, uninsured, poor, and refugees. Health industries in large cities face language barriers and cultural differences in recruitment and retention of employees. Recently health organizations have begun to hire newly arriving immigrant workers and temporary staff, who have been employed by hospitals, rehabilitation centers, and nursing homes in their native countries. How are these people managed?
The essential processes in managing diversity include communicating in clear language the institution’s policies and practices, establishing and running effective teams, obtaining cultural knowledge of employees and clients, and utilizing cultural competency as a benchmark for evaluating health care services.
To fully understand cultural competency, we need to know what the term “culture” means. Culture, in most cases, is seen as the sum total of the way in which people live, to include their values, beliefs, standards, languages, thinking patterns, behavioral norms, communication styles, and more. These elements guide groups in their decisions and actions through time. One example of a strong culture would be the Mormons or the Amish. Their way of life goes beyond a religious belief. One area that is never thought of as being a cultural component is the health belief system. Many cultures have beliefs surrounding the manner in which they categorize health and illness. These beliefs explain illness, the role nature plays in health and illness, and who should care and cure the ill. This provides a good foundation for understanding the absolute need for cultural competency in the health care industry, especially in a highly diverse society.
The most important cultural competency awareness is to understand how to deliver quality care. The following scenario will demonstrate how important it is to have some level of cultural awaren